October 25, 2019

What can be done for thoracic outlet syndrome?

Non-operative Care | Shoulder

Thoracic outlet syndrome is used to describe various conditions of the thoracic outlet, or the area between your collarbone and the beginnings of your ribs. These conditions happen when either or both the nerves and blood vessels get compressed or irritated.

The thoracic outlet is made up of nerves, muscles and blood vessels. The cause of thoracic outlet syndrome symptoms is pressure on these nerves, which is the result of shoulder muscles not being able to keep the collarbone in a stable position.

There are many reasons that shoulder muscles cannot keep the collarbone in place. These causes include:

  • Disease
  • Injury
  • Congenital issues, including problems with the ribs

Gender is a risk factor of the condition, as it is experienced more frequently by women.

Thoracic outlet syndrome symptoms

Most symptoms are the result of nerve compression. These symptoms include:

  • Difficulty with overhead motion as this increases compression.
  • Pressure. Nerve pressure causes slight pain in the upper extremities or neck. It can also cause numbness or tingling in the fingers or forearm. Pressure on blood vessels can lessen blood flow from the arm, which can cause swelling or redness.

Thoracic outlet syndrome exercises

These exercises can be done once symptoms are experienced. Exercises can be done a couple times a day with 10 reps each.

  • Stretch your neck. Put one hand on your head and the other on your back. Using the hand on your head, bring your head in the direction of your shoulder for a stretch. Switch hands and do it again to stretch the other side of your neck. Hold stretches for a few seconds.
  • Stretch your chest. Use a wall corner and place one hand on either wall. Lean in the direction of the corner until you feel a stretch in your chest. Hold the stretch for a few seconds.
  • Roll your shoulders. Rotate your shoulders in a circle motion both forwards and backwards.
  • Shoulder stretch. Bring your head back while keeping it in place and hold the stretch.

Thoracic outlet syndrome diagnosis

After a physical exam, tests may be performed. Thoracic outlet syndrome tests include:

  1. Raised arm stress test. This tests for the presence of symptoms. You will raise your arms and make fists for a few minutes to see if symptoms appear.
  2. Imaging. A doctor may want X-rays, MRI scans, CT scans or possibly even an ultrasound.
  3. Tests for blood circulation.
  4. Tests for nerve conduction.

Thoracic outlet syndrome treatment

Treatment is usually nonoperative for thoracic outlet syndrome. Treatment options include:

  • Physical therapy. Strengthening shoulder muscles can help the collarbone stay in place. Physical therapy can also help with posture. Bad posture increases the pressure on nerves and blood vessels.
  • Anti-inflammatories. NSAIDs, or nonsteroidal anti-inflammatory drugs, can help. These include medications like aspirin and ibuprofen, among others.
  • Losing weight. Weight adds stress to shoulder muscles that hold the collarbone in place.

If nonoperative treatment doesn’t work, surgery may be recommended. Surgery involves taking away part of the rib and/or tendon release, which relieves the muscle from the neck to the chest. Surgery, if done, is done by a cardiothoracic surgeon and usually not an orthopedic surgeon. 

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